MOH Holdings (MOHH) is the holding company for Singapore’s public healthcare entities. It undertakes several strategic initiatives for Singapore’s Ministry of Health (MOH) and public healthcare institutions, including the common employment of junior doctors and the joint recruitment of healthcare professionals for all public healthcare institutions. MOHH also develops and deploys talent management, human resources, and national IT frameworks for Singapore’s public healthcare sector.
MOH has created a national electronic health record (NEHR) system for Singapore’s public health sector. The NEHR system is available to all public healthcare institutions (comprising eight restructured hospitals, eight specialist centers, and 18 polyclinics), five community hospitals, two nursing homes, a hospice, selected general practitioners (GPs), and users from the Agency for Integrated Care (AIC).
The NEHR system aims to help clinicians improve the quality of healthcare for more than five million Singapore residents by providing them with more timely, harmonized, and accurate patient health information from a central repository of aggregated data from source systems.
The adoption of the NEHR system will allow MOHH to take a major step towards objectively measurable consistency and efficiency in the care-delivery process, across the healthcare continuum.
MOHH wanted to help clinicians improve the quality of healthcare for Singapore’s 5.18 million residents (as of 2011), by providing them with more timely, coordinated, and accurate patient health information from a central repository of consolidated data.
It also wanted to help clinicians to more accurately diagnose and treat diseases and chronic illnesses and ensure patient information was secure and available only to authorized healthcare practitioners.
In 2008, MOHH engaged Oracle Diamond Partner Accenture to help develop a blueprint for the NEHR system, which would be accessed by healthcare providers across Singapore’s public health sector. The following year, the Singapore Government announced that it was setting aside US$139 million (SGD$176 million) for the first phase of NEHR. In June 2010, an Accenture-led consortium was awarded the project to rollout the first phase, and work started in July 2010.
Under the arrangement, Oracle provided a central repository for healthcare data, and the middleware and identity management pieces of the NEHR system. MOHH purchased Oracle Healthcare Transaction Base, Oracle SOA Suite 11g, Oracle Database 11g, Oracle Database options Oracle Real Application Clusters, Oracle Advanced Security, and Oracle Database Vault, Oracle Identity Management 11g, and Oracle Enterprise Manager 11g.
These components work alongside a patient index, which maintains patients’ demographic data and matches their details from multiple source applications, and a clinical portal, which provides the front-end interface for clinicians to access medical data stored in the underlying Oracle infrastructure.
The NEHR system aims to help clinicians improve the quality of healthcare for citizens by capturing key information from multiple healthcare providers, and providing a summary of this information electronically to authorized healthcare providers in Singapore. The captured information includes medication histories, allergies, laboratory results, radiology results, and hospital inpatient discharge summaries.
Since June 2011, numerous public healthcare institutions have been progressively accessing NEHR, including acute and community hospitals, as well as an initial group of step-down care and primary-care providers, such as general practitioners, two nursing homes, and a hospice.
“MOHHs’ goal is to provide Singapore’s healthcare organizations with real-time, clinical information to help their clinicians more effectively diagnose and treat patients,” said Sari McKinnon, director, solutions and architecture, information systems division, MOH Holdings. “The NEHR system takes MOHH one step closer to achieving Singapore’s vision of One Singaporean, One Health Record.”
Oracle Healthcare Transaction Base is a clinical repository that securely aggregates clinical data, such as discharge and event summaries, and existing and previous medications, from source systems. The data is consolidated and presented as an aggregated summary for healthcare practitioners to view in the NEHR system and online. These records are stored in Oracle Database 11g.
MOHH is currently working with Oracle to try and achieve its target of presenting this data in less than two seconds.
MOHH deployed Oracle SOA Suite 11g to help it design, deploy, and integrate various reusable services and workflows that keep the NEHR system running smoothly. It also manages the exchange of data between existing clinical information applications and the NEHR system.
“Oracle SOA Suite is the exchange mechanism that is delivering patient data to healthcare practitioners using the NEHR system,” said McKinnon. “The main aim is to help them provide more informed care to patients by using a longitudinal, aggregated view of critical clinical-data summaries.”
Oracle SOA Suite also provides the flexibility to create new services. In addition, the application can easily be extended across the broader healthcare system in Singapore over the next few years, which would support the government’s vision to provide more timely and efficient healthcare to all Singapore residents.
Ensuring patient privacy is extremely important for hospitals and health clinics across Singapore. MOHH uses several Oracle solutions, alongside other components, to ensure patient information in the NEHR system is secure while providing healthcare professionals access to this data.
MOHH deployed Oracle Identity Management 11g to ensure each patient’s personal health information is not compromised. The application is used to authorize clinicians’ access when they log into the NEHR system to view medical information of patients under their care, such as medication histories and lab reports. The information is provided on a need-to-know basis.
“The aim is to legitimize the use of the system, so clinicians can provide the best clinical care and MOHH can promote confidence that patient information is being used in the right way,” said McKinnon.
Oracle Database Vault (an database option) is used to prevent MOHH’s IT administrators—who conduct regular maintenance of the NEHR system—from accessing patient records and other personal information by giving them only access to the information they need to do their jobs.
Oracle Advanced Security also provides an additional layer of security by encrypting Oracle Database files, which prevents files from being copied and opened at another location.
MOHH needed a solution that was already being used by other healthcare agencies with complex requirements. Oracle and Accenture provided reference sites, confirming that Oracle Identity Management 11g, Oracle SOA Suite 11g, Oracle Healthcare Transaction Base, and Oracle Database 11g worked well in large-scale public healthcare deployments.
“While the project received a lot of interest from technology providers, MOHH felt that the Oracle and Accenture consortium provided a suitable solution for its needs,” said McKinnon.
In 2008, MOHH engaged Oracle Diamond Partner Accenture to help develop a blueprint for the NEHR system. In June 2010, an Accenture-led consortium was awarded the project to roll out the first phase of the NEHR system.
Work on the NEHR project started in July 2010. The system went live in April 2011, and MOHH began rolling it out across numerous healthcare institutions in Singapore in June 2011.
Accenture was engaged to develop a blueprint that detailed the business, application, and technology architectures behind the NEHR system. From July 2010, Accenture worked with MOHH to map out the system requirements, design and build the NEHR system, and migrate historical patient data from the source systems.
Technical staff within the Accenture consortium used Accenture’s project methodologies and program management tools to deploy and test the system in 10 months.
“Accenture’s knowledge and resources were crucial to ensuring that this national project was completed within a tight timeframe,” said McKinnon.
Oracle Consulting, as part of the consortium, also provided healthcare and Oracle technology experts to assist with the implementation. This provided MOHH with additional assurance that any issues during the implementation would be addressed promptly, helping to reduce risk and ensure timely delivery of the project.